Provider Demographics
NPI:1912191354
Name:SCHELONKA, EDWARD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
Last Name:SCHELONKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CESERY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5667
Mailing Address - Country:US
Mailing Address - Phone:904-738-8775
Mailing Address - Fax:
Practice Address - Street 1:5434 SPRING BROOK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2392
Practice Address - Country:US
Practice Address - Phone:904-743-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine